Alert: DWC Retroactively Updates CA OMFS

Last Thursday, January 30, 2020, the California Division of Workers’ Comp (DWC) released a retroactive change to the 2020 Physician Fee Schedule. Announced in Newsline #2020-07, this is a correction to previous updates and applies retroactively to dates of service on or after January 1, 2020.

The Newsline explains that the DWC adopted Centers for Medicare and Medicaid (CMS) corrections to its Geographic Practice Cost Index (GPCI) data. These GPCIs are used to calculate workers’ comp fee schedule reimbursements for physician and non-physician medical treatment and services. Most importantly, the corrections apply retroactively to all Physician Fee Schedule reimbursements for dates of service on or after January 1, 2020.

To learn more about GPCIs and how these values are used to calculate Physician Fee Schedule reimbursements, watch our most recent free webinar:  #56 - CA OMFS Overview + Part 1 of 2020 Updates: Physician and DMEPOS Fee Schedules.

With this DWC announcement, DaisyBill immediately updated our billing software to reflect the new expected fee schedule reimbursements.

The table below provides an analysis of the GPCI correction and is organized by locality. The ‘% Diff’ column calculates the percentage differences in the originally adopted 2020 GPCI values as compared to the new GPCI values that the DWC adopted last Thursday.

Of the 32 localities in California, the following 7 localities were not affected by the GPCI corrections:

  • SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY) 
  • SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY)
  • SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY)
  • SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)
  • OXNARD-THOUSAND OAKS-VENTURA 
  • LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)
  • LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)

The remaining 25 localities were affected; some locality reimbursements changed by mere pennies while other localities experienced a more significant reimbursement change.

Locality Number

Locality Name

2020 PW GPCI

1/30/2020 Retroactively Adopted

2020 PE GPCI

1/30/2020 Retroactively Adopted

2020 MP GPCI

1/30/2020 Retroactively Adopted

% Diff

PW Diff

% Diff

PE Diff

% Diff

MP Diff

51

NAPA

1.049

1.238

0.496

-1.43%

-0.015

-3.72%

-0.046

1.21%

0.006

52

SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY)

1.068

1.299

0.481

-0.37%

-0.004

-1.15%

-0.015

4.16%

0.02

53

VALLEJO-FAIRFIELD

1.049

1.238

0.496

-1.43%

-0.015

-3.72%

-0.046

1.21%

0.006

54

BAKERSFIELD

1.032

1.07

0.677

-0.10%

-0.001

-1.31%

-0.014

0.44%

0.003

55

CHICO

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

56

FRESNO

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

57

HANFORD-CORCORAN

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

58

MADERA

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

59

MERCED

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

60

MODESTO

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

61

REDDING

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

62

RIVERSIDE-SAN BERNARDINO-ONTARIO

1.024

1.07

0.83

-0.29%

-0.003

-1.31%

-0.014

0.36%

0.003

63

SACRAMENTO--ROSEVILLE--ARDEN-ARCADE

1.033

1.078

0.58

-0.10%

-0.001

-0.56%

-0.006

1.55%

0.009

64

SALINAS

1.051

1.112

0.58

-0.10%

-0.001

-0.45%

-0.005

1.55%

0.009

65

SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)

1.072

1.279

0.58

-0.09%

-0.001

-0.39%

-0.005

1.55%

0.009

66

SANTA CRUZ-WATSONVILLE

1.038

1.16

0.58

-0.10%

-0.001

-0.34%

-0.004

1.55%

0.009

67

SANTA ROSA

1.038

1.142

0.58

-0.10%

-0.001

-0.35%

-0.004

1.55%

0.009

68

STOCKTON-LODI

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

69

VISALIA-PORTERVILLE

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

70

YUBA CITY

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009

71

EL CENTRO

1.024

1.07

0.606

-0.29%

-0.003

-1.31%

-0.014

0.50%

0.003

72

SAN DIEGO-CARLSBAD

1.032

1.13

0.607

-0.10%

-0.001

-0.44%

-0.005

0.49%

0.003

73

SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE

1.024

1.083

0.58

-0.29%

-0.003

-0.37%

-0.004

1.55%

0.009

74

SANTA MARIA-SANTA BARBARA

1.035

1.14

0.58

-0.10%

-0.001

-0.44%

-0.005

1.55%

0.009

75

REST OF CALIFORNIA

1.024

1.07

0.58

-0.29%

-0.003

-1.31%

-0.014

1.55%

0.009


DaisyBill’s Fee Schedule Calculator, the foundational tool of our DaisyWizard, automatically calculates reimbursements using the most recent Medicare files and DWC reimbursement formulas. Also, if you ever need to look up a historical rate, simply enter the date of service and billing code, then voila! Your expected reimbursement awaits you in all its mathematically accurate glory.

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